Senior Compliance Oversight Specialist, RN

🔥 42 minutes ago

🐊 Florida, Missouri – Remote

🐊 Florida – Remote 🏰 Missouri – Remote

⏰ Full Time

🟠 Senior

🚔 Compliance

👻 Ghost score 10%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Participate in auditing, monitoring, and oversight of Centene’s, its subsidiaries’, and third parties’/subcontractors’ corporate ethics and compliance program • Conduct audit, oversight, and monitoring activities to assess compliance with contractual and regulatory requirements • Collaborate with business owners and third parties/subcontractors to drive remediation • Prepare written reports on audit, oversight, and monitoring findings and recommendations • Direct compliance issues to appropriate channels for research and resolution • Review and evaluate corrective action plans and provide comprehensive follow-up • Support development and maintenance of monitoring and auditing tools for clinical aspects of government-sponsored health care program requirements • Assist with State Medicaid annual work plans and OIG and CMS work plans, including care management, utilization management, quality improvement plan management and oversight, and appeals • Educate and assist company personnel and third parties/subcontractors in meeting government-sponsored health care program requirements • Assess new and amended government-sponsored health care program contracts and requirements • Assist Health Plans, Subsidiaries, Shared Services, and Third Parties/Subcontractors in identifying and assessing compliance risks • Serve as a compliance advisor to business units and third parties, specializing in care management, utilization management, quality improvement plan management and oversight, and appeals • Perform other duties as assigned

🎯 Requirements

• Bachelor’s degree in Nursing or related field required • 5+ years of related experience required • RN or LPN required • Certified in HealthCare Compliance (CHC), Certified Compliance & Ethics Professional (CCEP), Certified Internal Auditor (CIA), or Certified Fraud Examiner (CFE) preferred • Previous experience in Care Management and/or Utilization Management preferred • Audit experience preferred • Must comply with all policies and standards

🏖️ Benefits

• Competitive pay • Health insurance • 401K • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Benefits may be subject to program eligibility

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